Undescended testicle

Disease Description (Causes and Symptoms)

• Definition: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that mainly begins in childhood and is characterized by persistent inattention, hyperactivity, and impulsivity. Symptoms appear in multiple settings (home, school, etc.) and affect daily functioning.
• Causes and pathophysiology:
  • Associated with an imbalance in the function of neurotransmitters such as dopamine and norepinephrine.
  • Associated with structural and functional differences in brain regions regulating attention and inhibition, including the frontostriatal circuits.
  • In some cases, acquired factors such as prematurity, brain injury, encephalitis, and fetal alcohol exposure may be involved.
• Main symptoms:
  • Predominantly inattentive type: inability to sustain concentration, frequent careless mistakes, failure to follow instructions, frequently losing items, etc.
  • Predominantly hyperactive/impulsive type: inability to sit still, excessive talking, difficulty waiting one’s turn, interrupting or disrupting others’ activities, etc.
  • Symptoms interfere with academic performance, interpersonal relationships, and daily life.
• Prevalence (reference values): Approximately 3–8% of school-age children; some studies report approximately 5% of elementary school students. It is reported more commonly in boys than in girls, and in some individuals (30–70%), symptoms may persist into adulthood.
• Possible comorbid problems: learning disabilities, depression and anxiety, mood disorders, conduct problems, etc.

Treatment Methods and Precautions

• Treatment goals: Reducing symptoms, improving academic and social functioning, preventing complications, and managing comorbid disorders.
• Nonpharmacological treatment (recommended in combination for all age groups):
  • Parent education (parenting skills, environmental modification)
  • Behavioral therapy and cognitive behavioral therapy (CBT)
  • School-based interventions (adjusting the classroom environment, breaking assignments into smaller parts, providing additional time, etc.)
  • Social skills training, educational therapy, play therapy, etc.
• Pharmacological treatment (recommended as first-line treatment for moderate or more severe cases or when functional impairment is prominent):
  • Stimulants (primary): methylphenidate preparations (short-acting and extended-release), amphetamine preparations — act quickly and are effective in many patients.
  • Nonstimulant: atomoxetine — has a more gradual effect but a different safety profile.
  • Alpha-2 agonists: guanfacine, clonidine — may help some patients (with sleep, impulse control, etc.).
  • Treatment duration: Long-term medication may be needed to control symptoms (from several months to several years in research and clinical practice), and discontinuation or adjustment should be determined through individualized assessment.
• Adverse effects and monitoring:
  • Common adverse effects: decreased appetite, weight changes, sleep disturbances, gastrointestinal symptoms, headache, restlessness, etc.
  • Stimulant-related: may increase heart rate and blood pressure; rarely, may induce psychiatric symptoms (anxiety, irritability, hallucinations, etc.).
  • Nonstimulant (atomoxetine): liver function abnormalities have rarely been reported.
  • Alpha-2 agonists: decreased blood pressure and pulse, drowsiness.
  • Recommended monitoring: Review baseline cardiovascular history and family history, track weight and height (growth), regularly measure blood pressure and heart rate, and observe mental status. If there is a cardiovascular history or symptoms, additional evaluation (e.g., electrocardiography) should be considered.
• Acute precautions (seek medical attention immediately if suspected):
  • Chest pain, fainting, severe shortness of breath, new severe depression or suicidal thoughts, or sudden changes in behavior or perception after taking medication, etc.
• Risk of complications: Decline in academic performance, low self-esteem, interpersonal problems, increased risk of accidents and injuries, and risk of substance abuse (especially when comorbid disorders are present).

Checklist Before an Outpatient Visit (Examples of Items to Bring and Records to Keep)

• Materials to bring:
  • List of currently taken medications (including doses and administration times), and history of previous medication treatment
  • Existing test results (cognitive or intelligence tests, attention tests, electrocardiography, etc.)
  • School records or comments from the homeroom teacher (a behavior observation form, if possible)
  • Family history (mental illness, ADHD, cardiovascular disease, etc.)
  • Growth tracking chart (height and weight), if possible for the most recent several years
• Symptom records (e.g., for at least the past 4 weeks):
  • Specific examples of when (in the classroom, at home, during play, etc.) and how particular symptoms occur
  • Sleep patterns, changes in food intake, frequency of distractibility, and examples of impulsive behavior
• Screening forms and questionnaires (complete in advance if possible):
  • Examples of standardized questionnaires: SNAP-IV, Conners, Vanderbilt, etc. (used at hospitals and schools)
• Other:
  • Treatment goals (changes expected by the parent and student) and concerns (adverse effects, school adjustment, etc.)

Examples of General Questions to Ask the Doctor

• "How did you confirm the diagnostic criteria? How do you distinguish it from other conditions?"
• "What are the advantages and disadvantages of the treatment (medication/nonmedication) you recommend?"
• "When will the expected effects of the medication begin, and how much improvement can we expect?"
• "What are the main adverse effects, and how should we respond if they occur?"
• "How often should monitoring (weight, blood pressure, heart, etc.) be performed during treatment?"
• "What kind of support (academic or behavioral interventions) should we request from the school?"

Examples of Disease-Specific Questions

• "To what extent do you expect this medication (e.g., methylphenidate) to help our child concentrate in class and complete homework? Are there specific measurable indicators we can use as goals?"
• "To minimize decreased appetite or sleep problems caused by the medication, what do you recommend regarding administration time, meal adjustments, and sleep hygiene?"

(Note: This content is general medical information. Individual diagnosis and treatment decisions should be made in consultation with the attending physician.)